Enhanced Task-Oriented Training in a Person With Dementia With Lewy Bodies

Abstract

Despite the inevitable loss of function seen in people with progressive dementias, interventions for reversing or minimizing functional loss are understudied. Research supports task-oriented training, but practical gaps in how to best evaluate clients for this training and how to implement it in clinical settings may be thwarting translation to occupational therapy practice. We structured an intervention model called STOMP (Skill-building through Task-Oriented Motor Practice) using a unique blend of task-oriented training and motor-learning principles. In this article, we describe through a case study the process and outcome of using STOMP to improve functional skills in a woman with moderate dementia with Lewy bodies. Our findings suggest that STOMP has the potential to serve as a structure for the evaluation and treatment of occupational performance deficits in people with dementia and that this model warrants further investigation.

Skill-building through Task-Oriented Motor Practice (STOMP) intervention for activities of daily living in dementia: study protocol for a randomized controlled clinical trial

“…Motor learning programs that emphasize repetitive practice of activities delivered through high-dose, intensive practice schedules (3–6 hours/day, 5 days/week, for 2 weeks) have repeatedly demonstrated permanent change in both brain structure (e.g., new connections to undamaged cerebral areas) and behavior (improved function), but is untested in dementia beyond our work (C. Ciro, Dao, et al, 2014; C. Ciro, Hershey, & Garrison, 2013; C.…”

“…Ciro, Dao, et al, 2014; C. Ciro et al, 2013), we determined a total sample size of 32 (16 per group) is required to detect a difference in 3-month mean Goal Attainment Scale (GAS) T-score values between the STOMP intervention group (M=52) and the comparison group (M= 37), with 80% power assuming a standard deviation of 14 and a 2-sided 0.05 alpha level.…”

Moving Toward 2017: Progress in Rehabilitation Intervention Effectiveness Research

“…Therapeutic taping using a unique tri-pull method to reduce glenohumeral subluxation in people poststroke was also described (Hayner, 2012). Task-based approaches to attain clientspecific goals for a patient with Lewy body dementia (Ciro et al, 2013) and to reduce severe cognitive impairment after stroke (Preissner, 2010) were also the focus of studies gauging the effectiveness of lowtech methods. Other interesting low-tech approaches studied included incorporating classical music into occupational therapy sessions to improve unilateral neglect after stroke , embedding relaxation and exercise training in a recovery program for people with breast cancerrelated lymphedema , and determining whether gel pads typically used in wheelchairs to reduce coccygeal pressure could be used for pressure reduction in medical patients when lying supine in bed (Thorne et al, 2009).…”

“…Two studies (Henshaw et al, 2011;Polatajko et al, 2012) addressed occupational performance through cognitive means (discussed in the next paragraph). In all, 12 studies used the COPM as an assessment tool (Beckelhimer et al, 2011;Ciro et al, 2013;Hayner et al, 2010;Henshaw et al, 2011;Hermann et al, 2010;Jack & Estes, 2010;McCall et al, 2011;Nilsen et al, 2012;Polatajko et al, 2012;Skubik-Peplaski et al, 2012;Wu et al, 2011;Zlotnik et al, 2009). Several research investigations conducted over the past 5 yr tested cognitive-based approaches.…”

“…An additional scoping review (2%) was performed by Hand et al (2011). A total of 15 articles (36%) described single-subject or case designs that used 2 or fewer participants (Beckelhimer et al, 2011;Carver, 2009;Ciro et al, 2013;Earley et al, 2010;Hardy et al, 2010;Henshaw et al, 2011;Hermann et al, 2010;Jack & Estes, 2010;Preissner, 2010;Rowe et al, 2009;Skubik-Peplaski et al, 2012;Sledziewski et al, 2012;Stapanian et al, 2010;Wu et al, 2011;Zlotnik et al, 2009). See Table 3 for additional information regarding participant numbers for the studies reviewed.…”